RESUMEN
BACKGROUND AND PURPOSE: We sought to examine the frequency and clinical relevance of intracranial artery stenoses in patients with bacterial meningitis in whom the occurrence of stroke has angiographically been reported to be associated with stenoses or occlusions of the large basal cerebral arteries. METHODS: Thirty-five unselected patients (24 men, 11 women; mean age, 51 +/- 18 years) with bacterial (n = 33) or fungal (n = 2) meningitis prospectively underwent serial transcranial Doppler sonography recordings of mean blood velocity (MBV) and pulsatility index in the middle (MCA) and anterior (ACA) cerebral arteries, as well as recordings of the ratio of the MBV of the MCA and internal carotid artery (MCA/ICA ratio) on days 1, 3, 5, 8, 14, and 21 after admission. The results were correlated with the Glasgow Coma Scale (days 1 to 14), the occurrence of focal cerebral signs, and the Glasgow Outcome Scale (short-term outcome, day 21). An MCA stenosis was diagnosed by an MBV of 120 cm/s or more or an MCA/ICA ratio of more than 3. An ACA stenosis was diagnosed by an MBV of 100 cm/s or more. RESULTS: Transient stenoses occurred most frequently between days 3 and 5 and were detected in 18 patients (51%). Seventeen patients remained without a stenosis. Patients with stenoses showed a significantly poorer mean Glasgow Coma Scale score from day 3 (9 +/- 4) to day 14 (11 +/- 4) than patients without a stenosis (day 3: 13 +/- 4, P < .01 by t test; day 14: 14 +/- 1, P < .05). The mean Glasgow Outcome Scale score was not significantly different between both groups. The occurrence of mainly transient focal cerebral signs was significantly related to the number of narrowed vessels per patient (P < .05, chi 2 test). CONCLUSIONS: Stenoses of the intracranial arteries occur frequently in bacterial meningitis and are associated with a complicated course of the disease.
Asunto(s)
Enfermedades Arteriales Cerebrales/etiología , Meningitis Bacterianas/complicaciones , Meningitis Fúngica/complicaciones , Adulto , Anciano , Enfermedades Arteriales Cerebrales/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ultrasonografía DopplerRESUMEN
OBJECTIVE: To determine whether treatment with the levorotatory form of hydroxytryptophan (L-5-hydroxytryptophan), a controversial experimental drug, can improve the conditions of patients with ataxia. DESIGN: A double-blind crossover study with the levorotatory form of hydroxytryptophan was performed in 39 patients with degenerative cerebellar diseases. SETTING: Patients were selected from an ongoing prospective follow-up study at two university hospitals. PATIENTS: We studied 19 patients with Friedreich's ataxia, 13 with cerebellar atrophy, and seven with olivoponto-cerebellar atrophy. INTERVENTION: The levorotatory form of hydroxytryptophan was given orally in a dose of 1000 mg/d. Each treatment phase, with the levorotatory form of hydroxytryptophan or the placebo, lasted 10 months, after which the treatment of patients was crossed over to the other phase. MAIN OUTCOME MEASURES: Ataxia was documented and quantified by using a clinical score, posturography, and measurement of grip force and the rapid-syllable repetition rate. RESULT: The levorotatory form of hydroxytryptophan had no significant effect on cerebellar symptoms. CONCLUSION: Long-term treatment with a high dose of the levorotatory form of hydroxytryptophan does not improve the conditions of patients with ataxia.
Asunto(s)
5-Hidroxitriptófano/uso terapéutico , Ataxia Cerebelosa/tratamiento farmacológico , 5-Hidroxitriptófano/análogos & derivados , Ataxia Cerebelosa/fisiopatología , Estudios Cruzados , Método Doble Ciego , Fuerza de la Mano , Humanos , Postura , Desempeño Psicomotor , HablaRESUMEN
The follow-up of neurophysiological tests (brain-stem auditory evoked potentials; blink reflex; sensory, motor and visual evoked potentials) and CT was investigated in 21 patients with late-onset cerebellar ataxia (CA) or multiple system atrophy. The study included an initial investigation and a follow-up examination on average 25.3 months later (minimum 8, maximum 36). Patients were divided into four groups: (1) those with pure CA after a minimum course of 5 years; (2) those with pure CA with pathological neurophysiological findings at the last examination; (3) those who at the first examination clinically presented with pure CA, but at the last examination were seen to have developed a multisystem disorder; (4) those with multiple system atrophy (mostly olivopontocerebellar atrophy) presenting additional non-cerebellar signs of involvement. Conforming to a strict interpretation of pure CA, group 1 patients invariably exhibited normal neurophysiological findings at all examinations. All patients in group 4, except for 2 only at the first examination, showed pathological changes in at least one of the neurophysiological tests. The main conclusion of this paper is that individuals who according to clinical criteria were initially classified as having CA but finally developed a multisystem disorder already had pathological neurophysiological findings at the initial examination (group 3). The increasing frequency of pathology in the several neurophysiological tests together with the progression of the disease is obviously of prognostic significance. CT revealed cerebellar atrophy without apparent involvement of brain-stem structures in all patients with CA; the majority of patients with multiple system atrophy also had atrophy of the brain-stem, pointing to olivopontocerebellar atrophy.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Encéfalo/patología , Ataxia Cerebelosa/fisiopatología , Adulto , Atrofia/diagnóstico por imagen , Atrofia/fisiopatología , Parpadeo/fisiología , Encéfalo/fisiopatología , Ataxia Cerebelosa/diagnóstico por imagen , Potenciales Evocados/fisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The value of brain CT-scan, magnetic resonance imaging (MRI) and angiography for diagnosis, differential diagnosis and follow up in Neuro-Behçet-Syndrome is assessed in 5 cases. Three of the patients presented with clinical signs of encephalitis. Further investigations led to the diagnosis of Behçet-Syndrome. CT-scan was negative in two of these cases, but MRI showed multiple, predominantly periventricular lesions with high signal intensity on T2-weighted spin-echo images in all three. Clinical symptoms improved with steroid and chlorambucil therapy in all three cases. In two patients the MRI-lesions resolved at least partially after 1.5 and 3 years of treatment respectively. In one patient the initial MRI-findings were still present after 7 months of treatment. The other two patients presented with headache, papilledema and increased CSF-pressure. The cause was superior sagittal sinus thrombosis, confirmed by angiography in both cases. Additional symptoms appeared later and led to the diagnosis of Behçet syndrome. One patient died of pulmonary aneurysms 28 months after the diagnosis had been established. The course of disease of the remaining patient is so far favorable.
Asunto(s)
Síndrome de Behçet/diagnóstico , Encefalitis/diagnóstico , Imagen por Resonancia Magnética , Examen Neurológico , Trombosis de los Senos Intracraneales/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Síndrome de Behçet/tratamiento farmacológico , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
Twenty patients diagnosed as suffering from autosomal dominant or idiopathic late onset cerebellar ataxia were investigated clinically, by means of neurophysiological tests (blink reflex, BAEP, SEP, MEP, VEP) and CT scan. Twelve patients presented with a pure cerebellar ataxia (CA) after a disease duration of at least five years (mean disease duration ten years). Eight patients presented with additional non-cerebellar signs of involvement; hence the disease was classified as olivo-ponto-cerebellar atrophy (OPCA). Eight of the twelve patients with CA already exhibited pathological results in at least one of the neurophysiological tests as subclinical evidence of a lesion beyond the cerebellum. Three of these patients showed an atrophy of brainstem structures in addition to the cerebellar atrophy. The ongoing prospective follow-up study will show whether these signs of subclinical involvement of non-cerebellar pathways are predictive for the development of a multi-system disorder in terms of OPCA. In cases of CA with subclinical signs of a lesion beyond the cerebellum there may be no clinical, non-cerebellar signs for a multisystem disorder even within a disease duration of up to fifteen years.